In Texas, a state grappling with high maternal mortality rates, especially among Black women, midwives are stepping into the spotlight as possible key players in a much-needed healthcare revolution. Advocates argue that midwifery could be part of the solution, with studies backing similar or better outcomes for low-risk pregnancies than traditional hospital births. However, the financial viability of this practice is jeopardized due to lower Medicaid reimbursement rates compared to physicians and many insurance plans not covering births outside of hospitals, according to a Houston Chronicle report.

Midwives in Texas attend significantly fewer births than some of their neighboring states; just 3% of births in 2022, Houston Chronicle noted. Sarah Slette, president of the Association of Texas Midwives, expressed her frustrations, emphasizing that the state does not value midwifery care as it should. High-profile program closures like that of the Texas Children's Hospital highlight these challenges, with the hospital suggesting the decision was necessary to strategically position for the future, despite acknowledging the significant impact their midwifery team has had in the statement obtained by the Houston Chronicle.

Conversely, the benefits of perinatal support extend beyond midwifery, with recent findings from the Elevance Health Public Policy Institute shedding light on doula services. Their report indicates that doula care led to better birth and postpartum outcomes, notably among Black patients and those in areas with inadequate OBGYN care. According to a KERA News story, this includes lower rates of C-sections and improvements in mental health postpartum.

Yet despite the evidence, doula services are not covered by Medicaid in Texas, a legislative barrier that proponents hope to address given that Texas Medicaid patients showed improved outcomes when doulas were involved, as Jennifer Kowalski of the Elevance Health Public Policy Institute highlighted in the KERA News report. The hope, Kowalski said, “Over time, knowing that we’re seeing such positive results from our study…that this encourages investment in doula workforce and that [patients] who need these services can access them more widespread than they do today.”